Pathways to Discovery: Spring 2011

It’s not uncommon for women to say, “I haven’t had sex in 3,
4, or 5 years because I didn’t know where to get help.”
—Stacy Tessler Lindau, MD, MAPP

Discussion about sexual performance is routinely part of treatment decisions for men with prostate cancer, but the same is not true for women with breast cancer or cancer of the gynecologic organs. That may change thanks to a unique UChicago clinic that helps female cancer survivors manage sexual problems related to their cancer or cancer treatment.

“What we know from our research is that 40%–60% of female cancer survivors face some kind of sexual dysfunction, but we think those numbers are conservative,” said Stacy Tessler Lindau, MD, MAPP, associate professor of obstetrics/gynecology and medicine and director of the Program in Integrative Sexual Medicine (PRISM) clinic.

In November, UChicago hosted a conference, in conjunction with Memorial Sloan-Kettering Cancer Center, in which clinicians and scientists from 20 states and 15 major cancer centers discussed ways to move this issue into the national spotlight and begin a multiinstitutional, evidence-based approach to monitor and evaluate treatment in this patient population.

“The group liked the idea of building upon the registry that has already been developed here,” explained Dr. Lindau. “We are the only ones tracking patients over time to see if they are getting better.”

Pain Most Common Complaint
Most patients who seek help from the PRISM clinic report experiencing pain during intercourse. “Pain is oftentimes the result of dryness or thinning of the vulva structures of the vagina,” said Dr. Lindau. “It’s not uncommon for women to say, ‘I haven’t had sex in 3, 4, or 5 years because I didn’t know where to get help.’”

Patients seeking help from the PRISM clinic can expect at least three visits. The first visit is used to gather an in-depth patient history, answer questions, provide counseling, and educate patients about the range of available treatment options. The second is a detailed gynecologic, rectal, and gastrointestinal exam, after which an initial treatment plan is developed, and follow-up is planned for visit three.

“Many of our patients benefit from just a little bit of estrogen cream,” said Dr. Lindau. “Other patients benefit from over-the-counter moisturizers or lubricants, while some need physical therapy and psychotherapy. We always use a team approach that includes discussion with the patient, the patient’s oncologist, and a psychologist.”

Treatments are generally covered by insurance because the problems are either a direct result of a patient’s cancer or cancer treatment, but Dr. Lindau said she worries about uninsured women, “There is no reason to believe that women without insurance aren’t experiencing these same problems and, in some cases, even worse problems because they are not getting regular healthcare.”

She said that virtually every woman who seeks help from PRISM and follows through with her appointments shows significant improvement.

Future Plans
Conference participants will get together again this fall at Memorial Sloan-Kettering in New York to advance implementation of a national registry. Meanwhile, Dr. Lindau is working with a cancer center in Peoria, Illinois, to create a program that is similar to PRISM that will offer comparable care and will begin to add data to the registry.

Advice for Women with Cancer
■ Talk about potential sexual problems with your physician
■ Understand that cancer-related sexual problems are common, and that they are physical problems, not a defect in your character
■ Regularly communicate with your partner and openly discuss sexual problems
For more information about cancer-related sexual problems, contact PRISM at
1-773-702-6123 or go to uchospitals.edu/prism.